Conference Paper

Nearly one-third of patients with primary brain tumors experience a seizure as the presenting symptom and another 30-50% develop seizures during the disease course. Despite a wide availability of anti-seizure medications, some brain tumor patients have treatment refractory seizures. Perampanel is a highly selective non-competitive-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) type glutamate receptor antagonist that is approved as an adjunct for partial-onset and primary generalized tonic-clonic seizures. We conducted a single-arm study to assess the safety, tolerability and efficacy of perampanel as an adjunctive anti-epileptic drug in patients with gliomas who have refractory partial-onset seizures. Participants were treated with a dose escalation of perampanel: 2 mg/day for two weeks, followed by 2mg-weekly increments up to a maximal dose of 8mg/day and then continued at this dose for 12 weeks. After 16 weeks of therapy, perampanel was tapered down by 2mg/week until the patients were no longer taking perampanel. Assessments included evaluations of Karnofsky Performance Status, seizure history, patient-reported outcomes of quality of life, and computer-based neurocognitive testing. Eight subjects were treated on study. Glioma subtypes represented: glioblastoma (n=1), anaplastic astrocytoma (n=3), anaplastic oligodendroglioma (n=1), oligodendroglioma (n=2) and diffuse astrocytoma (n=1). Seizure frequency varied widely between subjects. Three participants had clear reductions in seizure frequency after treatment initiation. The most common adverse events related to perampanel were fatigue (n=5) and dizziness (n=2). One participant died 8 weeks after study enrollment secondary to Pneumocystis jiroveci pneumonia and was deemed to be unrelated to perampanel. Of note, the study was stopped due to poor accrual. Adjunctive perampanel for patients with glial brain tumors and refractory partial-onset seizures is safe. Overall, this study suggests that perampanel is effective for refractory epilepsy in the brain tumor population but a larger study is needed to address definitively this question.

Full Text

Cited Authors

  • Dunn-Pirio, A; Woodring, S; Panta, S; Lipp, ES; Healy, P; Herndon, JE; Fountain, E; Desjardins, A; Randazzo, D; Friedman, HS; Peters, KB

Duke Contributors

Published Date

  • November 6, 2017

Published In

Volume / Issue

  • 19 / suppl_6

Start / End Page

  • vi168 - vi168

Published By

Electronic International Standard Serial Number (EISSN)

  • 1523-5866

International Standard Serial Number (ISSN)

  • 1522-8517

Digital Object Identifier (DOI)

  • 10.1093/neuonc/nox168.684

Conference Name

  • 22nd Annual Scientific Meeting and Education Day of the Society for Neuro-Oncology

Conference Location

  • San Francisco, CA

Conference Start Date

  • November 16, 2017

Conference End Date

  • November 19, 2017